反流性食管炎92例内镜,食管pH监测,测压,胃动力观察

反流性食管炎９２例内镜、食管ｐＨ监测、测压、胃动力观察梁国士，卢干，康交阳，党彤，刘彬胃食管反流病（Ｇａｓｔｒｏｅｓｏｐｈｇｅ－ａｌｒｅｆｌａｘｄｉｓｅａｓｅ，ＧＥＲＤ）是常见病、多发病。２４小时食管内ｐＨ监测及内镜对反流性食管炎（Ｒｅｆｌａｘｅｘ－...     

Losec治疗食管源胸痛止痛效果的评价

应用洛赛克（Ｌｏｓｅｃ２０ｍｇ／ｄ）对７８例食管源胸痛进行了止痛效果的临床观察，全部患者经内镜，食管测压，酸反流试验等形态学和动力学检查诊断。研究结果表明：Ｌｏｓｅｃ对各种原因引起的食管源胸痛均有明显的止痛效果，总有效率为８２．１％；与硝苯啶联合服用对由高张力型食管运动障碍引起的胸痛止痛有效率为７４．１％，明显高于单用硝苯啶组３６．８％（Ｐ＜０．０５）。     

食管内镜检查4228例

食管内镜检查４２２８例郭慧平１李志洁２李靖３林晓银１Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｅｓｏｐｈａｇｉｔｉｓ／ｄｉａｇｎｏｓｉｓ；ｅｓｏｐｈａｇｅａｌｎｅｏｐｌａｓｍｓ／ｄｉａｇｎｏｓｉｓ；ｅｓｏｐｈａｇｏｓｃｏｐｙ主题词食管炎／诊断；食管肿瘤／诊断...     

胃粘膜中增殖细胞核抗原及p53、K-ras、bc1-2基因蛋白的表达

为了解胃粘膜癌变过程中多基因蛋白的表达及意义，应用免疫组化技术检测１０７例内镜活检胃粘膜组织中增殖细胞核抗原（ＰＣＮＡ）及ｐ５３、Ｋ－ｒａｓ、ｂｃ１－２基因蛋白。结果各基因蛋白阳性率随病变程度加重而增加。Ⅲ型肠化生者增殖细胞核抗原标记指数（ＰＣＮＡＬＩ）及Ｋ－ｒａｓ、ｂｃ１－２基因蛋白阳性率较之Ⅰ、Ⅱ型肠化亦有增高趋势但未见统计学差异（Ｐ≥０．０５）。１２例Ⅲ型肠化中有９例出现Ｋ－ｒａｓ或ｂｃ１－２蛋白异常表达（７５．０％），显著高于Ⅰ、Ⅱ型肠化（２３．８％）（Ｐ＜０．０５）。在肠型及胃型胃癌ｐ５３表达率为５３．３％、３７．０％（Ｐ＞０．０５）；Ｋ－ｒａｓ为４０．０％、７．４％（Ｐ＜０．０５）；ｂｃ１－２为９３．３％、５９．３％（Ｐ＜０．０５）。１５例肠型胃癌中有９例同时存在２种或２种以上蛋白异常表达（３例ｐ５３与ｂｃ１－２表达异常，２例ｂｃ１－２与Ｋ－ｒａｓ表达异常，４例ｐ５３与ｂｃ１－２、Ｋ－ｒａｓ异常表达），高于胃型胃癌（Ｐ＜０．０５）。结果提示以上基因产物的表达异常与胃粘膜癌变相关，Ⅲ型肠化属于胃癌癌前病变范畴，肠型胃癌发生发展的分子机制与胃型胃癌显著不同。     

老年反流性食管炎

反流性食管炎（ｒｅｆｌｕｘｅｓｏｐｈａｇｉｔｉｓ）是指由胃、十二指肠内容物反流入食管而引起的组织损害，属胃食管反流性疾病（Ｇａｓｔｒｏ－ｅｓｏｐｈａｇｅａｌｒｅｆｌｕｘｄｉｓｅａｓｅ，ＧＥＲＤ）。近年来，随着内镜检查的广泛开展及便携式２４ｈ食管ｐＨ监...     

内镜结扎术治疗食管静脉曲张32例

内镜结扎术治疗食管静脉曲张３２例王宏利１黄裕新２闻勤生２王新２Ｓｕｂｊｅｃｔｈｅａｄｉｎｇｓｅｓｏｐｈａｇｅａｌａｎｄｇａｓｔｒｉｃｖａｒｉｃｅｓ／ｔｈｅｒａｐｙ；ｌｉｖｅｒｃｉｒｒｈｏｓｉｓ；ｌｉｖｅｒｎｅｏｐｌａｓｍｓ；ｇａｓｔｒｏｓｃｏｐｙ主...     

食管贲门良恶性狭窄的内镜扩张术

食管贲门良恶性狭窄的内镜扩张术苏鲁洪梅燕潘洪珍本文总结了５１例上消化道狭窄进行８５次扩张治疗的结果。一、临床资料：５１例中，男４３人，女８人，平均年龄３９．６岁（２．５～７１岁）。病种包括腐蚀性食管炎８例、手术后狭窄１４例、食管和贲门癌１５例、返流性...     

多聚酶链式反应在慢性乙型肝炎血清学标志物检测中的应用

作者应用多聚酶链式反应检测９５例慢性乙型肝炎患者的血清标本，ＨＢｓＡｇ、ＨＢｅＡｇ、抗－ＨＢｃ阳性组，ＨＢｓＡｇ、抗－ＨＢｅ、抗－ＨＢｃ阳性组，ＨＢｓＡｇ、抗－ＨＢｃ阳性组，抗－ＨＢｓ阳性组，抗－ＨＢｅ，抗－ＨＢｃ阳性组其ＨＢＶＤＮＡ阳性率分别为９６．５５％（２８／２９例），７８．９５％（１５／１９例），４０％（８／２０），２０％（２／１０例），１０％（１／１０例），并提出乙型肝炎病毒复制和传染性     

食管胃底静脉曲张内镜下诊断和治疗规范试行方案

(中华消化内镜学会２０００年３月１日至３日在昆明通过 )食管胃底静脉曲张内镜下记录及分级标准一、食管静脉曲张 (ｅｓｏｐｈａｇｅａｌｖａｒｉｃｅｓ,ＥＶ)（一）记录方法１．形态 (Ｆｏｒｍ,Ｆ)Ｆ０:ＥＶ已消失 (作为治疗后的描述 )Ｆ１:ＥＶ呈直线形或略有迂曲Ｆ２:ＥＶ呈蛇形迂曲隆起Ｆ３:ＥＶ呈串珠状 ,结节状或瘤状附记 :如ＥＶ不同形态同时存在 ,应选择最重的记录。２ .基本色调 (ｃｏｌｏｒ ,Ｃ)（１）白色静脉曲张（ｗｈｉｔｅｖａｒｉｃｅｓ,Ｃｗ）（２）蓝色静脉曲张（ｂｌｕｅｖａｒｉｃｅｓ,ＣＢ）３．红色征 (ｒｅｄｃ…     

小量噻嗪利尿剂对血清尿酸的影响

有人认为噻嗪剂利尿剂能增加血尿酸,ＡⅡ受体阻断剂Ｌｏｓａｒｔａｎ（Ｌｏｓ）能降尿酸。本文验证该假说。血尿酸在治疗前,治疗后４个月检查一次。病人随机分成４组治疗：一般治疗组Ｌｏｓ５０ｍｇ;Ｌｏｓ５０ｍｇ＋氢氯噻嗪（Ｈｃｔｚ）１２．５ｍｇ;Ｌｏｓ５０ｍｇ...     

Short-term treatment of gastroesophageal reflux disease

OBJECTIVE: To investigate the efficacy of acid suppressant drugs in the empirical treatment of gastroesophageal reflux disease (GERD) and in the treatment of endoscopy-negative reflux disease (ENRD). DESIGN: medline, embase, and the Cochrane Controlled Trials Register were searched. Bibliographies were reviewed. SETTING: Studies were eligible that compared the short-term use of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) with each other or with placebo in adults with GERD who were enrolled irrespective of endoscopic findings (empirical cases) or in whom endoscopy showed no signs of esophagitis (endoscopy-negative cases). MEASUREMENTS: Of 1,408 studies, only 13 could be included for meta-analysis. Data on 3,433 patients empirically treated for GERD and 2,520 patients treated for ENRD were extracted. The primary endpoint was relief of heartburn. MAIN RESULTS: In the empirical treatment of GERD, the summary relative risk (sRR) for symptom relief from H2RAs versus placebo was 0.77 (95% confidence interval [95% CI], 0.60 to 0.99). RR in the only placebo-controlled PPI trial was 0.35 (95% CI, 0.26 to 0.46). The sRR for standard dose PPIs versus H2RAs was 0.55 (95% CI, 0.44 to 0.68). In treatment of ENRD, both PPIs (sRR, 0.64; 95% CI, 0.52 to 0.79) and H2RAs (sRR, 0.78; 95% CI, 0.62 to 0.97) were superior to placebo, and PPIs were superior to H2RAs (sRR, 0.81; 95% CI, 0.70 to 0.95). CONCLUSIONS: Acid suppressant therapy (with a PPI or an H2RA) is more effective than placebo for short-term relief of heartburn in patients with persistent symptoms who are treated empirically for GERD and in those in whom esophagitis was excluded after endoscopy. The benefit of PPIs compared with H2RAs is more pronounced in patients treated empirically.     

Omeprazole in H2 receptor antagonist-resistant reflux esophagitis

We conducted a retrospective review of 25 patients with severe reflux esophagitis treated with omeprazole because of failure of H2 receptor antagonists to heal their esophagitis. Prior to beginning omeprazole (40 mg/day), all patients were on H2 antagonists for at least 9 months and still had endoscopic evidence of longitudinal (grade II) or circumferential (grade III) distal esophageal ulceration. Omeprazole therapy brought about complete endoscopic healing in 24 of 25 patients (96%). Twenty-three of 24 healed patients were then restarted on H2 antagonists as maintenance therapy. Repeat endoscopy was performed if symptoms recurred. Fourteen of 24 patients (58%) had recurrence of endoscopic esophagitis documented between 26 and 300 days from the time of starting maintenance therapy. Two of these 14 patients opted for antireflux surgery, whereas the remaining 12 were once again given omeprazole, which again resulted in symptom resolution in all patients. These data suggest that most patients with H2 receptor antagonist-resistant ulcerative esophagitis cannot be successfully maintained on H2 antagonists even after the ulcers have been healed with omeprazole. Further studies are required to determine the role of omeprazole compared to other treatments in the long-term maintenance therapy of these patients.     

Comparative study of nizatidine and famotidine for maintenance therapy of erosive esophagitis

BACKGROUND: The therapeutic effect of combined administration of prokinetics and histamine H2 receptor antagonists (H2RA) in gastroesophageal reflux disease is reported to be superior to that of monotherapy with H2RA alone. In addition to its acid-suppressing effect, the H2RA nizatidine also has a prokinetic action by suppressing acetylcholine esterase. The present multicenter, randomized controlled study was performed to investigate whether nizatidine is superior to famotidine, which does not suppress acetylcholine esterase activity, in maintenance therapy for erosive esophagitis. In addition, the question as to whether the grade of erosive esophagitis affects the non-recurrence rate during the maintenance therapy with H2RA was also investigated. METHODS: Seventy-two patients with endoscopically healed erosive esophagitis after 8 weeks of initial treatment with proton pump inhibitors were randomly divided into two groups. Patients in the nizatidine group were treated with 150 mg nizatidine twice a day (b.i.d.), while patients in the famotidine group were treated with 20 mg famotidine b.i.d. for 6 months. At the end of therapy, and at the time when patients complained of symptoms, endoscopic investigations were repeated to find out whether the esophagitis had recurred. RESULTS: Nizatidine produced a significantly higher non-recurrence rate than famotidine (P = 0.049 in intention-to-treat [ITT] analysis). This difference of remission rate between nizatidine and famotidine was observed mainly in grade B esophagitis (P = 0.016 in ITT analysis). CONCLUSION: Nizatidine is a more effective H2RA than famotidine in the maintenance therapy of patients with reflux esophagitis.     

Influence of Helicobacter pylori eradication on reflux esophagitis in Japanese patients

The relationship between Helicobacter pylori eradication and reflux esophagitis is controversial. We analyzed the development of reflux esophagitis and the change in the grade of pre-existing reflux esophagitis after eradication. Enrolled were 559 Japanese patients who received eradication therapy for H. pylori . The grade of reflux esophagitis by endoscopy before and after therapy was evaluated retrospectively. No esophagitis was present before eradication in 526 patients. H. pylori was and was not eradicated in 429 and 97, respectively. Reflux esophagitis developed in 40 of the eradication group and in three of the treatment failure group, with prevalence higher with successful eradication ( P  = 0.04). Successful eradication and hiatus hernia were significant risk factors for reflux esophagitis development. Twenty-seven of 33 patients with pre-existing reflux esophagitis had successful eradication and six treatment failure. The reflux esophagitis grade worsened in two (Los Angeles classification from A to B) and improved in 14 patients after eradication. With treatment failure, reflux esophagitis worsened in none and improved in three patients. There showed no significant change in the grade of pre-existing reflux esophagitis after H. pylori eradication but the sample size was too small to evaluate the difference. In conclusion, the eradication of H. pylori increases the prevalence of reflux esophagitis, and hiatus hernia was a significant risk factor for the development of reflux esophagitis.     

Treatment of Reflux Esophagitis Resistant to H2-Receptor Antagonists with Lansoprazole, a New H+/K+-ATPase Inhibitor: A Controlled, Double-Blind Study

This multicenter, randomized, double-blind, 8-wk study compared the new H⁺/K⁺-ATPase inhibitor, lansoprazole, 30 mg daily, to ranitidine 150 mg bid for treatment of erosive reflux esophagitis resistant to his-tamine-2 receptor antagonists (H2RA). Patients were evaluated after 2, 4, 6, and 8 wk of treatment by symptom assessment and endoscopy. Healing rates for lansoprazole were 71%, 80%, 88%, and 89% at 2, 4, 6, and 8 wk, respectively, compared to 21%, 33%, 45%, and 38% for ranitidine ( p < 0.001 at all points). Lansoprazole was significantly more effective than ranitidine for relief of heartburn and reduction of antacid tablet use. Increases in serum gastrin concentrations between the baseline and the 8-wk visit were greater in lansoprazole-treated than in ranitidine treated patients. Lansoprazole was safe and well tolerated. In patients with erosive reflux esophagitis resistant to standard doses of H2RA, lansoprazole 30 mg/day is more effective than continuation of an H2RA (ranitidine 150 mg bid) for healing of esophagitis and improvement of symptoms.     

Helicobacter pylori eradication improves pre-existing reflux esophagitis in patients with duodenal ulcer disease.

BACKGROUND & AIMS: There has been significant controversy over the relationship between Helicobacter pylori infection and reflux esophagitis. We investigated the effects of eradicating H. pylori on the reflux esophagitis found in patients with peptic ulcers. METHODS: Prospective posteradication evaluations were conducted yearly in 162 H. pylori-positive patients who had reflux esophagitis together with peptic ulcer disease (4 women and 158 men, mean age = 49.1 yr). The Los Angeles classification of the patients' esophagitis was: grade A, 90; grade B, 63; and grade C, 9. The follow-up evaluations began 1 to 2 months after completion of the eradication treatment (mean time of follow-up = 22 mo), and consisted of endoscopy and an interview focusing on heartburn. RESULTS: Six patients were withdrawn from the study because of adverse drug reactions or a failure to regularly keep their appointments. After eradication therapy, we observed endoscopically that reflux esophagitis had improved in 87 (55.8%) of the 156 patients. The improvement rate was significantly higher in patients cured of infection (60.8%) than in those with persistent H. pylori infection (38.9%) (P = 0.04). Body mass index (odds ratio = 0.86, 95% confidence interval [CI] = 0.76-0.97), cure of infection (3.68, 95% CI = 1.56-8.69), the absence of a hiatal hernia (3.90, 95% CI = 1.83-8.28), and an ulcer located in the duodenum (2.75, 95% CI = 1.33-5.70) were identified as significant independent factors for the improvement of reflux esophagitis. CONCLUSIONS: In patients with reflux esophagitis associated with duodenal ulcer, a significant improvement in pre-existing reflux esophagitis was noted after H. pylori eradication.     

艾普拉唑联合莫沙必利治疗反流性食管炎疗效观察

目的观察艾普拉唑联合莫沙必利治疗反流性食管炎的效果。方法96例临床症状及内镜检查明确诊断为反流性食管炎的患者,随机分为艾普拉唑组49例、奥美拉唑组47例。艾普拉唑组口服艾普拉唑10mg,2次／d;奥美拉唑组VI服奥美拉唑20mg,2次／d;两组同时均加用莫沙必利5mg,3次／d餐前服,疗程4周。治疗过程中定期观察症状改善情况、检测基础胃酸分泌,疗程结束时内镜复查。结果在缓解症状、降低基础胃酸分泌、改善食管炎症等方面,艾普拉唑组优于奥美拉唑组（P〈0．05）。结论艾普拉唑联合莫沙必利治疗反流性食管炎,能有效持续降低胃酸分泌,减少食管酸反流,促进食管黏膜修复,缓解胃食管反流症状。     

Clinical features and endoscopic progression of gastroesophageal reflux disease.

OBJECTIVES: 1. To determine the progression of endoscopic affectation in patients with gastroesophageal reflux disease (GERD). 2. To analyze the clinical parameters associated to grade IV of esophagitis, as well as the degree of endoscopic progression. MATERIAL AND METHODS: between 1996 and 2002, 692 patients with GERD have been followed prospectively (66% men and 33% women, with a mean age of 50.7 years). All were submitted to initial upper endoscopy, without treatment, and different clinical parameters associated to grade IV esophagitis were analyzed. During follow up, a new endoscopy was repeated in the event of symptomatic relapse, comparing the new findings with those of the initial exploration. RESULTS: the initial endoscopy did not reveal signs of esophagitis in 49% of the patients. Grade I 11.2%, grade II 22%, grade III 8.1% and grade IV 8.7%. Multivariant analysis showed that advanced age (p <0.01), male sex (p <0.03), smoking (p <0.02) and absence of infection due to Helicobacter pylori (p <0.02) were independent factors associated to grade IV esophagitis. Throughout follow up, patients without esophagitis did not show evidence of esophagitis in successive endoscopies, and a higher grade was found in only 3 of the patients. CONCLUSIONS: the endoscopy did not reveal signs of esophagitis in approximately half of the patients. Advanced age, male sex, smoking and absence of Helicobacter pylori are risk factors associated with severe stages of esophagitis. Patients with reflux without esophagitis did not develop inflammatory disorders during follow-up, while those with esophagitis remained in the stage of the initial diagnosis.     

Gastroesophageal reflux: the features in elderly patients

INTRODUCTlONWiththeintroduction0fintraesophageal24-hpH-m0nitoringinclinicalpractice,itisnowpossibletoidentifypatternsofgastroesophagealreflux(GER)inthehealthypeopleandpatientsandtoassesstheeffectofH2blockersandH oc adenosinetriphosphatase(ATPase)inhibitorsonGERdiseasesL1Ai7I.ItisincreasinglyrecognizedthatsymptomaticGERmayoccurinthepatients0fallages.However,littleinformationisavailableonsymptomaticGERpatternsintheelderly.Recently,Moldetal,investigatedGERdisease(GERD)inpatientsag…     

Corpus gastritis and erosive esophagitis: a report from the Middle East.

OBJECTIVE: To assess whether corpus gastritis due to Helicobacter pylori protects against erosive esophagitis in an area with high prevalence of H. pylori infection. METHODS: Biopsies obtained from gastric corpus and antrum in 151 patients with symptoms of gastroesophageal reflux disease were studied for presence of H. pylori and endoscopic evidence of gastritis. Presence and grade of esophagitis at endoscopy was recorded. RESULTS: Fifty-four (36%) patients had endoscopic esophagitis. Patients with severe esophagitis (>or= grade II) less often had active gastritis (15/45 vs. 55/98; p=0.02) and had a lower density of H. pylori (p=0.0003) than those without esophagitis. CONCLUSION: Active corpus gastritis due to H. pylori infection may protect against erosive esophagitis in patients with gastroesophageal reflux disease in the Middle East.